Individual
DR. GREGORY CUSANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1401 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2113
(713) 432-1100
(713) 432-0221
Mailing address
14275 MIDWAY RD STE 400, ADDISON, TX 75001-3661
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
L4319
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
L4319
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155683901
—
TX
01
—
220033317
RR MEDICARE
TX
01
—
8G2491
BCBS
TX
Enumeration date
07/01/2005
Last updated
12/02/2025
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